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Tuesday, March 23, 2010

Some Random Obamacare Comments

1. By 2019 there are reports that there will still be 21M uninsured. The new coverage to 32 million does not cover everybody since, depending on the estimate, there are more than 32M uninsured people.

2. CBO did a static analysis that yielded the "cost savings" and "no budget deficit" with this bill. There are a number of assumptions unique specifically to that bill. Put your thinking cap on though. Do you really believe you can lay a $500B tax on rich people and have no effect on investment, and thus, job prospects? CBO doesn't measure the alternative use of the $500B tax transfer from private to public sector.

3. One of my favorites is the description I saw of how children can stay on their parents plan until age 26. So 26 is now deemed a child? If my kids are still loafing on my insurance plan that long, there's a chance I've done something wrong. In any event, except for cases where young adults have handicaps, this is ridiculous.

4. The only possibly good points were the coverage for pre-existing conditions. But it could have been handled in a more efficient manner through establishing high-risk pools for these people to subsidize them or work out some sort of tax scheme. Otherwise, it's very likely insurance premiums will go up for small businesses.

5. The evil insurance companies will have to pass on the costs of these mandates. It will become less affordable and more costly as a direct result of this legislation than it would have been compared to the status quo. No doubt Obama will come out angry and blame insurance around January, after the elections, when they jack their premiums to their business customers because of the mandates.

6. Congress will not allow a tax in 2018 they couldn't stomach in 2010. This will undercut the savings that yielded a magically budget neutral effect on the overall budget deficit.

7. Holding hospitals accountable for "results" incentivizes doctors to take patients most likely to have a good outcome so they get "results". Too bad if you're old, fat, perceived as lazy by the doc...

8. Primary care docs will make references to specialists so long as the threat of a lawsuit is there. With this bill, it will likely incentivize even more pointless CYA references.

9. The idea that a central point of data administered by the center for medicare and medicaid (CMMS) will lead to great effectiveness will only be useful if the doctors use them. Medical technology has long been available. If the docs, who the hospitals revolve around, don't use it (as they haven't) it seems wishful thinking to believe they will do so now to such a degree will get major benefits. Although this is potentially ripe for benefits. But me of lil' faith!

10. Expecting CMMS to run efficiently is wishful thinking. Expecting an Agency like this to play a key role in cost containment is a joke. Who knows maybe all the GS-12s and 13s and the contractors they bring in will manage a miracle. Maybe they'll be uber-motivated to squeeze costs out. I'm sure they'll work round the clock rather than clocking out at 3:30. I'm sure.

11. This puts a ridiculous, unsustainable cost burden on the states. States share Medicare costs with the Feds. Guess how the Feds are paying for this? By cutting funding reimbursement to docs and to states who won't be able to say no. If I were the Governor of a state I would be horrified about what this is going to do to my budget over the next decade. They're already facing massive budget cuts. You ain't seen nothing yet.

12. This will also crush private health insurance in the long run. As we march towards single payer, that was the real intent anyway wasn't it?

Obama promised to take a scalpel to budget cuts in his campaign. He could have done that by dealing with the specific problems such as the problem with people with pre-existing conditions. Instead, he took out his sledgehammer and gave us all an uppercut.